Lub cev hepatobiliary yog ib qho kev ua haujlwm ntau theem uas tso cai rau cov txheej txheem tseem ceeb xws li kev zom zaub mov thiab tshem tawm (kev tshem tawm cov khoom metabolic ntawm lub cev). Qhov tshwm sim ntawm nws qhov kev puas tsuaj yog ua txhaum ntawm cov txheej txheem metabolic, txheej txheem detoxification, nrog rau kev tiv thaiv kab mob thiab tiv thaiv kab mob.
Lub cev ntawm cov kab mob hepatobiliary
Lub kab mob hepatobiliary muaj lub gallbladder, daim siab thiab cov kua tsib. Nws txoj haujlwm tseem ceeb yog kev tsim thiab kev thauj mus los ntawm cov kua tsib, uas yog tsim los ntawm lub siab hlwb. Los ntawm cov ducts, nws txav mus rau lub gallbladder, uas yog ib tug ntxiv reservoir. Cov kua tsib uas khaws cia hauv nws yog 5-10 npaug ntau dua li lub siab. Tom qab noj mov, nws nkag mus rau lub lumen ntawm duodenum. Lub anatomy ntawm lub hepatobiliary system, ntxiv rau lub siab thiab lub gallbladder, muaj xws li cov intrahepatic biliary ib ntsuj av, uas yog nyob rau hauv ncaj qha rau hauv lub gallbladder.daim siab. Lawv, pib ua cov kua tsib capillaries, maj mam dhau mus rau hauv cov kua tsib loj dua uas txuas mus rau lub siab. Cov ducts extrahepatic bile yog sawv cev los ntawm cov kab mob siab thiab cov cystic ducts, uas, thaum sib xyaw ua ke, tsim cov kua tsib ntau.
Bile, nws lub luag haujlwm hauv lub cev
Lub luag haujlwm ntawm cov kua tsib, uas suav nrog cov electrolytes yaj hauv dej, cov hlau hnyav (tooj liab) thiab cov organic (cov kua tsib ntsev thiab cov kua qaub, cov roj cholesterol, bilirubin thiab ntau lwm yam), muaj ntau haiv neeg. Ua ntej tshaj plaws, nws koom nrog hauv emulsification ntawm cov rog, thiab tseem txhim kho cov hydrolysis thiab nqus cov protein thiab carbohydrates. Cov kua tsib yog ib qho catalyst rau kev ua haujlwm ntawm plab hnyuv thiab pancreatic enzymes, yog li txhawb txoj kev zom zaub mov thiab nqus cov rog thiab cov vitamins A, D, E, K.
Ntxiv nrog rau kev ua haujlwm zais cia, cov kua tsib kuj ua lub luag haujlwm tswj hwm lub cev, tswj cov kua tsib thiab cov kua tsib tso tawm, cuam tshuam rau lub cev muaj zog thiab zais cia ua haujlwm ntawm cov hnyuv me. Nws yog koom nrog hauv kev tsis ua haujlwm ntawm peptin thiab hydrochloric acid, uas yog ib feem ntawm cov kua txiv hmab txiv ntoo, txhawb kev loj hlob (loj hlob) thiab desquamation ntawm cov kab mob hauv plab hnyuv epithelial, cuam tshuam rau kev tso tawm ntawm cov hnoos qeev. Tsis tas li ntawd, nws koom nrog hauv kev ua kom tsis zoo ntawm ntau yam tshuaj lom thiab tshuaj.
siab
Anatomy ntawm lub hepatobiliary system suav hais tias lub siab tsis yog tsuas yog lub hauv paus hauv nruab nrab ntawm cov kua tsib, tab sis kuj yog tib neeg lub cev tseem ceeb tshaj plaws. Nws nyob ntawm no tias feem ntau ntawm lub zog ntawm lub cev yog tsim, vim 20% ntawm cov cell loj,Cheebtsam ntawm lub siab yog nyob los ntawm mitochondria uas synthesize ATP. Lub siab yog lub caj pas loj tshaj plaws hauv tib neeg lub cev, uas ua kom lub cev tsis tu ncua ntawm ib puag ncig sab hauv ntawm lub cev. Nws plays lub luag haujlwm tseem ceeb hauv cov protein, rog thiab carbon metabolism, nrog rau cov metabolism hauv cov tshuaj. Lub siab yog ib qho ntawm ob peb lub cev uas raug kev ntxhov siab tas li, tab sis tib lub sijhawm lawv muaj peev xwm rov qab los ntawm lawv tus kheej hauv lub sijhawm luv luv. Hauv lub cev, nws ua haujlwm hauv qab no:
- biliary tsim thiab tso zis;
- metabolic - ntxiv rau kev sib txuas ntawm ntau yam (cov protein, cov roj cholesterol, glycogen, urea) tsim nyog rau kev ua haujlwm ntawm lub plab zom mov, lub siab tswj cov dej metabolism thiab cov metabolism ntawm cov amino acids thiab cov protein, carbohydrates, Cov rog thiab cov tshuaj lom neeg lom neeg;
- tso nyiaj - daim siab yog ib hom khoom noj uas muaj cov protein, carbohydrates, rog, vitamins, cov tshuaj hormones, minerals accumulates;
- thaiv - txawv teb chaws thiab tshuaj lom uas nkag mus rau hauv lub cev nrog zaub mov lossis tsim hauv txoj hnyuv yog neutralized ntawm no;
- excretory - lub siab muaj peev xwm tshem tawm cov tshuaj lom uas nkag mus rau hauv cov kua tsib, uas, vim nws muaj pes tsawg leeg, tshem tawm ntawm lub cev;
- homeostatic - synthesis, tsub zuj zuj thiab tawg ntawm cov ntshav plasma Cheebtsam, tshwj xeeb, immunoglobulins, cov khoom ntawm coagulation system tshwm sim hauv daim siab.
Ua rau muaj kev puas tsuaj rau cov kab mob hepatobiliary
Kev ua haujlwm tsis zoo ntawm cov kab mob hepatobiliary, tshwj xeeb hauv daim siab, feem ntau yog tshwm sim los ntawm kev ua ntawm cov tshuaj sib xyaw ua ke. Cov no suav nrog raug tshuaj lom, kab mob thiab kis kab mob, dawb radicals. Tsis tas li ntawd, cov kab mob hepatobiliary tuaj yeem raug kev txom nyem los ntawm ntau yam hormonal thiab metabolic ntshawv siab, noj zaub mov tsis zoo, noj tshuaj tsis tswj, haus cawv. Kev ntxhov siab kuj tuaj yeem ua lub luag haujlwm tseem ceeb hauv qhov tshwm sim ntawm ntau yam pathologies.
Hom kab mob ntawm cov kab mob hepatobiliary
Cov tshuaj niaj hnub paub qhov txawv ntawm cov kab mob hauv qab no uas ua rau muaj kev ua txhaum ntawm cov kab mob hepatobiliary:
- Mitochondrial - cov kab mob no tshwm sim ntawm qib cellular thiab muaj nyob rau hauv ib feem ntawm cov kab mob ua pa enzymes. Feem ntau lawv yog cov txiaj ntsig ntawm kev siv tshuaj tua kab mob (tetracyclines), tshuaj tua kab mob, cov khoom noj parenteral. Qhov tshwm sim ntawm cov kab mob no yog fibrosis, qee zaum kev loj hlob ntawm cov ducts yog ua tau.
- Protein dystrophy tshwm sim vim kev ua txhaum ntawm protein synthesis. Feem ntau, cov kab mob no yog tshwm sim los ntawm cov tshuaj lom mus ntev (cawv, tshuaj, kab mob thiab kab mob, tshuaj lom).
- Fibrosis tsim vim kev puas tsuaj rau tshuaj. Feem ntau lawv tshwm sim los ntawm cov tshuaj cytotoxic. Nws tshwm sim los ntawm kev loj hlob ntawm cov ntaub so ntswg fibrous, uas, cuam tshuam cov ntshav khiav, ua rau muaj kev nce siab hauv cov hlab ntsha portal thiab cuam tshuam kev ua haujlwm ntawm daim siab hlwb.
- Cholestasis -txo qis ntawm cov kua tsib nkag mus rau hauv duodenum, los yog nws tsis tuaj. Yog vim li cas rau qhov no tej zaum yuav yog ib tug mechanical obstructions (gallstones) los yog mob uas tshwm sim nyob rau hauv cov theem ntawm daim siab hlwb thiab intrahepatic bile ducts.
- Cov kab mob vascular - tuaj yeem pom lawv tus kheej ntawm ntau theem ntawm nws cov hlab ntsha sib txuas, xws li los ntawm cov hlab ntsha mus rau kev puas tsuaj rau cov hlab ntsha ntawm cov hlab ntsha thiab cov hlab ntsha ntawm lub portal.
- Bile thickening - qhov no pathology ntawm cov kab mob hepatobiliary feem ntau tsim los ntawm kev txhaws ntawm cov ducts los ntawm mucous los yog kua tsib plugs. Feem ntau nws tshwm sim hauv cov menyuam yug tshiab thiab cuam tshuam nrog kev tsis sib haum xeeb hauv Rh factor.
Symptoms
Kab mob ntawm cov kab mob hepatobiliary, raws li txoj cai, muaj cov tsos mob tshwj xeeb thiab tsis yog tshwj xeeb. Cov tsos mob tsis tshwj xeeb suav nrog cov tsos mob intoxication, tshwm sim los ntawm lethargy, qaug zog, qaug zog thiab kub taub hau thaum lub sij hawm exacerbation ntawm tus kab mob. Lawv cuam tshuam nrog kev txo qis hauv kev ua haujlwm detoxification ntawm lub siab, tuaj yeem nqus cov kua tsib los yog cuam tshuam hauv cov protein, carbohydrate lossis vitamin metabolism. Cov tsos mob tshwj xeeb suav nrog cov kev tshwm sim uas tshwm sim thaum cov kab mob hepatobiliary raug cuam tshuam ncaj qha. Cov no suav nrog:
- ntau yam kev zom zaub mov (xws li xeev siab, hnyav hauv txoj cai hypochondrium, ntuav ntuav los ntawm kev noj zaub mov, raws plab);
- mob hauv plab "hauv lub plab" lossis nyob rau sab xis, feem ntau tshwm sim tom qab nojcov zaub mov muaj roj los yog haus luam yeeb;
- daim tawv nqaij tshwm sim (kab laug sab leeg, xanthomas, pigmentation tsis meej, jaundice);
- ascites - tsub zuj zuj ntawm cov kua hauv lub plab kab noj hniav;
- kev txhim kho ntawm cov venous qauv ntawm lub plab;
- muaj daim siab tsis hnov tsw ntawm qhov ncauj.
Kev mob siab ntawm cov kab mob hepatobiliary hauv cov menyuam yaus
Cov kab mob hepatobiliary hauv cov menyuam yaus muaj feem tsawg dua li cov neeg laus mus rau cov txheej txheem inflammatory tshwm sim los ntawm cov kab mob sib kis. Ntau zaus, nws cov pathologies cuam tshuam nrog kev ua haujlwm tsis zoo. Lawv tuaj yeem kuaj tau hauv cov menyuam yaus hnub nyoog sib txawv, tab sis feem ntau lawv cuam tshuam rau cov menyuam kawm ntawv. Qhov no yog vim muaj kev nce siab hauv kev xav, kev xav thiab lub cev, nrog rau kev hloov pauv ntawm kev noj haus. Qhov tseem ceeb ntawm qhov tshwm sim ntawm kev ua haujlwm tsis zoo yog txhim kho kev loj hlob thiab kev hloov hormonal hauv tus menyuam lub cev. Feem ntau nyob rau lub sijhawm no, kev kuaj mob biliary dyskinesia, tsawg dua - cholecystocholangitis thiab cholecystitis.
Nws yog ib txwm ua kom paub qhov txawv nruab nrab ntawm cov kab mob thawj thiab theem nrab ntawm cov kab mob hepatobiliary. Cov kab mob tseem ceeb tuaj yeem cuam tshuam nrog ob qho tib si nrog cov kab mob anatomical ntawm lub biliary ib ntsuj av, thiab nrog rau qhov tsis xws luag hauv cov sphincters uas tswj kev txav ntawm cov kua tsib, tshwj xeeb, sphincter ntawm Oddi. Kev ua haujlwm tsis zoo thib ob tuaj yeem tshwm sim nrog cov kab mob hauv qab no:
- gastroduodenal (peptic ulcer, duodenitis);
- pathology ntawm pancreas;
- metabolic ntshawv siab;
- kab mob parasitic.
Diagnosis
Txawm li cas los xijNtawm qhov kev nce qib tseem ceeb ntawm cov kab mob hepatology niaj hnub no, muaj qhov nce ntau ntawm cov kab mob ntawm cov kab mob biliary thiab lawv txoj kev nyiam mus ntev thiab kev kawm ntev, yog li kev kuaj mob raws sij hawm dhau los ua txoj haujlwm tseem ceeb. Ntxiv nrog rau kev kuaj mob, kev kuaj keeb kwm thiab kev kuaj sim, cov ntaub ntawv tshaj plaws uas tuaj yeem suav hais tias yog ntshav biochemistry, cov hauv qab no ntawm kev kawm cov kab mob hepatobiliary pab txiav txim siab lub xeev ua haujlwm.
- Computer tomography - ntau zaus ua los tswj cov nqaij mos ntawm cov ntaub so ntswg ntawm lub plab, cov ntaub ntawv tshaj plaws nrog kev tswj hwm cov hlab ntsha ntawm cov neeg ua haujlwm sib txawv.
- MRI - tso cai rau koj txhawm rau txheeb xyuas ntau yam kab mob ntawm daim siab cov ntaub so ntswg thiab cov hlwv, tso cai rau koj los tshuaj xyuas thiab kuaj cov hlab ntsha hauv cov txheej txheem oncological.
- Radionuclide scanning - tso cai rau koj los ntsuas qhov tso tawm ntawm cov kua tsib thiab ntau yam kev hloov pauv hauv daim siab cov ntaub so ntswg, txheeb xyuas cov txheej txheem qog, foci ntawm qhov mob thiab ntsuas qhov patency ntawm cov kua tsib.
- Cholangiography tuaj yeem kuaj pom pob zeb thiab qog nyob rau hauv cov ducts, nrog rau qhov muaj fistulas thiab lwm yam pathologies ntawm biliary ib ntsuj av. Tsis tas li ntawd, qhov kev ntsuam xyuas no tso cai rau koj coj cov qauv ntawm cov kua tsib thiab cov kab mob hauv cov kab mob hauv lub cev, nrog rau kev ntxig ib lub catheter thiab tso cov kua tsib, ua kom cov ducts dilates thiab muab cov tshuaj uas yaj cov pob zeb (gallstones).
- Angiography ntsuas cov ntshav ntws hauv lub portal thiab cov hlab ntsha siab. Nws yog qhov tseem ceeb rau kev txiav txim siab qhov sib txawv ntawm kev mob oncological ntawm daim siab.
- Ultrasound ntawm lub cevhepatobiliary system yog qhov yooj yim tshaj plaws, siv tau yooj yim tshaj plaws thiab cov ntaub ntawv tshawb fawb txoj kev. Nws tso cai rau koj txheeb xyuas cov pob zeb hauv lub gallbladder thiab cov ducts, zoo rau kev kuaj xyuas ascites.
Ultrasound ntawm lub cev ntawm lub cev hepatobiliary
Kev npaj yuav tsum tau ua rau txoj kev kawm no yooj yim heev, tab sis tsim nyog kom tau txais daim duab tag nrho. Nws lub hom phiaj yog kom txo qis cov pa roj hauv cov hnyuv kom cov plab hnyuv tsis thaiv qhov pom ntawm cov kabmob hauv qab kev kawm. Ua li no, nyob rau ua ntej ntawm kev ntsuam xyuas, koj yuav tsum tau ua ib tug cleansing enema los yog noj ib tug laxative. Rau cov txheej txheem kom ua tau zoo raws li qhov ua tau, peb hnub ua ntej nws yuav tsum ua raws li kev noj haus uas txo cov txheej txheem ntawm kev tsim roj. Kev ntsuam xyuas yuav tsum tau ua rau ntawm lub plab khoob, tsawg kawg yog 8 teev yuav tsum tau dhau los txij thaum noj mov kawg.
Kev noj zaub mov ua ntej ultrasound
Thaum ua ultrasound ntawm lub cev ntawm lub cev hepatobiliary, kev npaj yuav tsum muaj xws li, ntxiv rau cov txheej txheem ntxuav, noj zaub mov uas txo cov roj tsim. Nov yog nws cov ntsiab cai:
- pluas mov yuav tsum yog feem - tsawg kawg plaub zaug ib hnub twg, thiab noj mov kawg yuav tsum yog tsawg kawg 2 teev ua ntej yuav mus pw.
- Lub ntim ntawm cov kua yuav tsum raug txo rau ib thiab ib nrab litres.
- Tsis suav nrog cov zaub mov noj uas suav nrog cov poov xab, nqaij rog lossis ntses, legumes, qab zib, tshuaj yej lossis kas fes, dej qab zib lossis dej cawv.
Lub cev hepatobiliary ua ntau lub luag haujlwm tseem ceeb hauv tib neeg lub cev, thiab tshawb pom kev ua txhaum cai raws sijhawm hauv nws txoj haujlwm yuav pab kom tsis txhob muaj ntau yam teeb meem yav tom ntej.
